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And we're actually going to move on to our second competition of the day. And we're gonna start by um looking at our best abstracts. So for those of you that have been following all of the spam that we've been putting on Twitter and all over our social media for the last few months, you will see that we've been hosting an abstract competition and actually, we've got a number of fantastic projects that are in our poster rooms. You can go and take a look at those in your own time. Um But what I'd like to do is I'm going to um share with you a couple of videos to start with that have been submitted from our best abstracts and then we're going to do some question and answer. So to start with, if you'll forgive me, I've just got to share my window and then what we're going to do is we're going to hear from MS Pinto and her project about a virtual joint school prior to Arthroplasty. So I'll let you all listen to this for the next couple of minutes. So we can't hear it. Apologies. You can't hear it. How can I make that better. Give me a second, apologies about that. I'm wondering if uh sue my tech guru might be able to help me with this. Give me a second. I knew that at some point. Share the tab, not the window. Okay, apologies. Oh, there we go. Sorry, I pressed the wrong thing. You have to forgive me. Mm Not that one. I want to share this one though. There we go. Sorry, sorry, you have to forgive me. I'm going to go back to the beginning. Hopefully that works now. Good afternoon. My name is Deepika Pinto and I would like to share with you today our experience here at his Pt Gwynedd in Bangor with a virtual joint school prior to hip and knee arthroplasty in terms of patient feedback and carbon footprint savings. It is well known that preoperative joint schools are helpful in reducing patient anxiety and improving their understanding of surgery and it even reduces length of stay and decreases readmissions. In fact, the Royal College of Surgeons has provided guidance that patient's waiting for elective surgical interventions should be invited to attend such groups, surgery schools, conducting these schools in a face to face format has some disadvantages. However, it is time consuming. A lot of information is given in a short span of time which is difficult for patients to comprehend. It involves a deal of traveling for the patient's and finally COVID restrictions made it further more difficult to conduct these face to face sessions. We therefore present our model of a virtual joint school which was started at this party, Gwinnett with support from the Welsh government, which commissioned the Red More TLC partnership to help run these virtual group clinics. The first step consisted of a series of online educational videos, expanding on various aspects of hip and knee arthroplasty which were provided online on youtube and which patient's waiting for hip or knee surgery were invited to watch. Next patient's on the wait list for surgery were invited to attend an interactive virtual session. Each session being attended by 8 to 10 patient's and being run by an MD D team consisting of nurses, physiotherapists, occupational therapist, the RT plastic coordinator, as well as a former patient who was invited to share their lived experience. We obtained feedback from patient's in the form of an electronic questionnaire which was administered perspectively and also assessed the environmental impact by calculating the travel miles and time saved by attending the joint school in a virtual format between July 2022 and February 2023 267 patient's attended this virtual joint school auth. Um 44% responded to our questionnaire. About 89% of patient's found that the videos on youtube were helpful and easy for them to understand. 94% felt that their concerns were the simple adequately and 97% felt that they had adequate opportunity to ask questions during the interactive sessions, 84% of patient's felt that they had adequate support from the health board to attend the meetings which were conducted on the team's format. And 65% also had support from family or friends to attend. The same 98% of patient's was happy with the level of confidentiality involved in the virtual sessions. And when asked to rate their prep redness for surgery on scale of not pretend with 10 being the best. After watching the educational videos alone, patient's had a median prep redness of six which increased to a median of nine after attending well director sessions and finally then asked whether they would like to attend future such joint schools virtually or face to face. 86%. We're happy to attend them in the works will format. Coming to the environmental impact. We found that each patient saved on average 53 minutes of travel to and from the hospital which amounted to a total savings of 274 hours of travel and each patient saved on average 38 miles of travel to run from the hospital amounting to a savings of 10,017 miles across. All patient's that attended the Jones School virtually in the same month speeded converting this into carbon footprint savings. We found that for a single session of the joint school, having it run in a face to face format would produce around 91 kg of carbon dioxide. Whereas having it run virtually produce just 0.32 kg of carbon dioxide representing an immense saving. There were some limitations to our study. The response rate was limited at just 44% and some patient's were unable to attend the school virtually because of technical problems. So and so we did run a few clinics face to face to accommodate these. And finally, the hospital did need to invest in the technical skill to run these virtual joint schools. We also discovered some additional benefits. However, the virtual joint schools allowed patient's relatives to be involved in their treatment journey. It allowed patient education to begin earlier right at the time of listing for surgery and even at the point of contact with their GP. And finally, it encouraged an overall digital transformation based on this. We have certain plans for the future, including waiting bell videos, virtual orthopedic rehabilitation. And we also hope to extend the virtual format two consenting in the form of digital consenting and digital prompts collection and follower. Thank you very much. Oh dear. I mean, give me a second. I hope that we've got Deepika here. I know that she is on call today. Are there? She is? Hello. Hi. Um I was just wondering Mr Sopa. Have you got any questions or Dr Ranga? Gee, have you got any questions for Deepika today about her virtual joint school? Oh, I think you're still on mute. Thanks. Um I don't have any questions at the moment. I thought that was a good presentation. I think um the question that I've got is you said that one of the limitations was that you only had a 44% response rate. Um Have you worked out if there are any reasons for that or if there is anything that you might be able to do to improve the feedback so that we can try to get a bit more of an understanding. Yeah, so I think one of the reasons for it still continues to be the technical difficulty with it given that are arthroplasty population is uh elderly age group. Uh They do tend to struggle a bit with the technology involved. Uh Despite that being the fact, we were surprised that quite large percentage of people were able to attend the meetings with some support from family and with a lot of support from the health board as well. I think that this didn't translate into doing the electronic questionnaire. Uh But one of the things that we have considered is because we've been anecdotally getting good feedback from patient's who've been coming into hospital to have their surgery, telling us that they really enjoyed the joint school. So probably we could have a survey done when they are in hospital, which would probably be good to get a better response rate about the virtual joint school as well. That's fantastic. Thank you so much for your time today and I'm so sorry to have disturbed you whilst you're in the middle of your on call shift. Thank you for giving me the opportunity to present on this conference. Thank you very much. Thank you very much. Um I'm going to hopefully not mess this one up, but I'm gonna allow us to present Mr James Bentley's project. I'm going to throw him under the bus somewhat and say that he's unable to join us because of the signal at the Glastonbury Festival site is rather prohibitive from him being able to answer any questions, but we've got a fabulous video from him which I'm just going to hopefully sort out now for us and hopefully we'll be able to go from there. I'm going to turn off my mind. Good afternoon, everyone. My name is James Bentley and together with my colleagues at Queens Medical Center in Nottingham, we performed an evaluation of the environmental impact of wrist splint usage at our, at our fracture clinic. The NHS in England is currently responsible for approximately 20 million tons of carbon dioxide emissions annually and spends over 50 million lbs a year on carbon permits. The NHS is aiming to become carbon emissions net zero by 2040 this was placed into legislation in July last year with the release of the Health and Care Act. Disposable wrist splints are extremely common adjunct that we provide to our patient's across our clinics and these contain a removable aluminium bar. Aluminium is responsible for approximately 2% of all greenhouse gas emissions and its production relies heavily on high energy smelter's. These splints are inevitably thrown away as know recycling scheme is currently in place. We calculated the number of wrist splints purchased by the our fracture clinic over a one year period, weighed the aluminium bars and worked out the total mass of aluminium uh used over 12 months from this were therefore able to determine the carbon footprint of wrist splint usage in our fracture clinic. Over 12 months, we purchased just over 1300 response with each aluminium bar weighing 21 g. This led to just under 28 kg of non recycled aluminium per year being used just from response as per the 2015 Paris Agreement for every ton of aluminium created around 4.8 tons of carbon emissions are produced. Therefore, we were able to work out the our response contribute approximately naught 0.13 tons of carbon into the atmosphere per year. This however, could be an underestimate with regions that use coal based power to create um aluminium creating up to 20 tons of carbon per ton. Therefore, the figure could be as high as just over half a ton of carbon produced. Uh Yeah, for our aluminium sprint splints in real terms, this is approximately same as driving from Queens Medical Center to Edinburgh or if the higher half a ton of carbon uh figures to be used the same as driving from Paris to belgrade to conclude disposable response are a simple and extremely common adjunct commonly provided in our clinics. These contribute to the carbon footprint of the NHS and no recycling scheme is currently in place to recycle the aluminium bars. Recycling aluminium obviously creates much less CO2 implementing a recycling scheme at the QMC Fracture Clinic would be a simple and effective thing to do and would be a simple way of contributing towards the net zero goal of the NHS. Now, admittedly, our numbers don't sound big. However, it's important to remember that our calculation is a massive underestimate. We didn't include the splints handed out by other departments. We also didn't include the environmental impact of packaging uh for the wrist splints including non recyclable plastic. And when we apply this 276 acute trusts across the NHS, there is therefore significant potential environment mental impact from just one, very simple, very basic adjunct. We therefore recommend implement in our practice click implementing a recycling bin for wrist wrist splints infract clinic, offering this recycling policy to include other adjuncts such as Zimmer Splints, thumb Speicher's and frames, etcetera. And considering the appointment of a recycling officer to oversee the recycling scheme, something that we believe would help push towards the net zero goal of the NHS and potentially reduce costs. I've included a list of references here at the end of my presentation and thank you very much. Has anyone got any questions? Thank you very much for that. Um I thought that was an excellent presentation. I don't have any further questions for that. I think I, I tried to talk with James earlier today and the phone signal just wasn't allowing us to do that. Um He expressed his apologies that he wasn't able to come and join us. But again, I agree that that was, that was a fantastic project and it really showed just one simple measure what we are able to do. Um And then now I'd like to welcome to this stage, our final presenter for our abstract competition. We've got Gin Way low who's going to. So if you want to come to the stage, um we will gladly watch your presentation. Thank you very much. Hi, good afternoon, everyone. My name is in and I'm currently working as the orthopedic clinical Fellow in the Royal Infirmary of Edinburgh. And first of all, thanks for giving me the opportunity to present our project in this conference. So today I would like to present to you our projects on the topic of a cost and water consumptions. Analyst is of different surgical hand. I'm so sorry to interrupt you. Have you got something to do? You want to share with us something on the screen or is it just you talking? Just don't forget to share with us your lovely slides that you worked so much prepare. No, it's not a problem. Is it sharing now? Yes, that's share ing fabulous. Okay. Yep. Okay, perfect. Thank you. So, the project that I'm going to present today will be on the cost and what the consumptions analysis of different surgical hand disinfection techniques in a natural plastic unit in Scotland. So as we all know that global warming is a longer prediction's anymore, it is happening right in front of us on the earth that is inhabited pires. And according to our Scottish Environment Protection Agency, climate change is likely to lit more pressure in areas that have not yet experienced water crisis. And the only way to tackle this problem is to take urgent action to protect water resources for critical activities before the actual water crisis takes place and efforts to minimize what the consumptions in operating theaters have demonstrated the reductions in resource wastage and carbon emissions. However, only very limited studies demonstrated the outcomes exclusively within automatic surgery. The next line is going to be a brief introductions on the revolutions of surgical hand disinfection techniques. So historically, in 18 sixties, Sir, Joseph Lister demonstrated the effect of these infections on the reductions of surgical site infections. At that time, surgical glows were not yet available that by making a proprietor dis infections of the surgical site of the patient and hand anti sepsis by the surgeons is even more imperative. During the 19th century, surgical hand preparation consisted of washing the hands with antimicrobial soaps and warm water alongside frequently with the use of a brush. Later in the second half of the 20th century, waterless alcohol based surgical hand disinfectants becomes alive. So we look into various studies and most studies show similar efficacy when comparing both surgical hand disinfection techniques, which are between the traditional scrubbing is with alcohol base. So versus the newer one with the waterless alcohol based hand Robbins techniques and for your interest, I have included the tightest of those these studies that we have looked in the both light as you can see. So given that orthopedic operating theaters are resource intensive in terms of what the usage as compared to other parts of the hospital. My team and I have decided to carry out this project mainly to look into the cost analysis and also to investigate into the amount of water that could potentially be saved by practicing different techniques. So we created a question there and we distributed the questions. They're on the preferred surgical hand disinfection techniques to a group of a tra plastic surgeons who operate in our unit. So they run to least daily on a daily basis based on the responses we calculated the average durations require in each technique. We also calculate the amount of water the disinfectants use in each techniques and we then calculate the rest their respective costs. The result that we manage together is used to extrapolate to provide an annual estimate of result. So we look into 3 million types of techniques. The first one which is widely used in our local hospital in the Royal Infirmary of Edinburgh is by using the hydrates and voiding solutions for three minutes, followed by sterile. Ian's using the traditional water tap technique. We also look into the technique which is widely used in our neighbor hospital in the NHS FIVE. They use the scrubbing using the motion sensor water tap. And we also look into the waterless technique which is by just scrubbing with 90 seconds of sterile in without using any water. So in terms of our measurement, we measure the amount of what they use using a calibrated what bucket flowing out from the what tap. And then we calculate the flow rate based on per minute. We also calculate the amount of disinfectant use based on the number of palms. And then we then measure the volume of each pond accurately using calibrated strange. So over a two week period, we managed, we have 46 cases done and of these 46 cases, it gives a total of 183 scripts and that gives an average of four scrubs per case. And we managed to gather 14 respondents and out of these 14 respondents, we managed to gather that for the average duration of the first case. It is about four minutes and the average duration for subsequent cases of the day is about three minutes. And as you can see here, the majority of the ultra plastic surgeons scrubs using four minutes of hydrox plus 30 seconds of sterile. Um for the first case of the day. And as for the subsequent cases of the day, majority of them still uses three minutes of hydrox followed by 30 seconds of sterily. Um's and surprisingly, only one of them uses 90 seconds of sterily um for the subsequent scrubs of the day. So this table shows uh cost analysis of three different type of technique that we look into. And as you can see by using the traditional water tab, it cause it consumes about 26.4 liters of water for one single scrub. And as for the motion sensor water tap, which is used in our neighbor hospital in five, it only used 11.7 liters. And as you can see for the waterless technique using sterily, um it does not use any water at all and interestingly is the cheapest options among the other two. Uh This table shows the two week period in our troll plasty unit, the um total amount of water use was 5000 liters of water and it cost about 107 lbs. And if we compare it with our neighbor hospital in the NHS five, the amount of total water use is less than half of it, which is only 2300 liters of water. And when using a water efficient surgical hand disinfection technique which consists of a single four minute scrubbing with a motion sensor tab. For the first case followed by waterless handler out using the steri. Um for subsequent cases, the total amount of water use is only 1000 liter and it only costs 45 lbs. Yeah, just one minute. I just want to let you know. Yeah, okay. And the water efficient surgical hand disinfection that it can save a significant amount of water. And also in terms of total cost. So using this data, we use it to extrapolate into a one year analysis result. And we can see that using a motion sensor water tab could save 75,000 liters of water. And while using the water efficient technique, it will save more than 100,000 liters of water and about 1600 lbs in total cost. We would like to admit that our project is limited to two main factor which is the short duration of the study period. And also we did not include the full life cycle assessment. We did not include the cost, use the energy used to hit up the water and then the cost to replace the traditional water tap with the motion sensor, water tap. And in conclusion, the data from our studies show motion sensor tag and what the efficient technique could save water usage. And we are hoping to use this to inform our hospital management team and also to inform our arthroplasty practitioners on the potential water saving from using these techniques. And hopefully this could ultimately help to reduce the carbon foot brain and automatic surgery. And that's the end of my presentations. Thank you. Fantastic. Thank you very much. Um I really enjoyed your presentation there and actually it was really nicely mirroring everything that we heard from MS You Margie just now. I wanted to, did anyone have any questions? Did you have any questions, Mister A sopa? Um No, I thought that was a very good talk. Thank you very much. Thank you very much. Um I think the question that I've got is really um what do you think the barriers are to being able to introduce an alcohol based handrub? Because I think we've all seen that the numbers are there from a sustainability point of view, from a water reduction point of view and from a cost point of view. But I wonder what are the barriers for us getting people using this more widely? Yes. So interestingly, we did include these questions in our questions there when we distributed them to the arthroplasty practitioners. And most of the response from them saying that they are quite comfortable with their current practice at the moment and that give them a very low infection rates. So they are not very willing to change their practice. And some of them did mention saying that they don't think that what the crisis is actually a problem in the UK, especially in Scotland. And some of them did mentions that sometimes it is just the availability issues of those surgical hand disinfectants like sterily. Um Sometimes we can't find them in the theater just because of the shortage of the supply sometimes. Um Yeah, I think that your answer was is good, but it does raise a few other points that we need to consider when we're making changes. So what are the consequences of changes? And people always ask those questions? So, um any quality improvement project needs to consider those? Thank you. Thank you. That's fantastic. Thank you very much. Um We will be announcing the winner of our best abstract presentation later on this afternoon alongside when we announced the winner of our 1500 lb oruk seed fund for the best project.